Neuropsychologia 46 (2008) 2993–3005

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Neuropsychologia
journal homepage: www.elsevier.com/locate/neuropsychologia

A case of persistent retrograde amnesia following a dissociative fugue:

Neuropsychological and neurofunctional underpinnings of loss
of autobiographical memory and self-awareness
Kristina Hennig-Fast a,∗ , Franziska Meister a , Thomas Frodl a , Anna Beraldi a , Frank Padberg a ,
Rolf R. Engel a , Maximilian Reiser b , Hans-Jürgen Möller a , Thomas Meindl b
a
Department of Psychiatry and Psychotherapy, Ludwig-Maximilians-University, Nussbaumstr. 7, D-80336 Munich, Germany
b
Department for Clinical Radiology, Ludwig-Maximilians-University, Ziemssenstrasse 1, D-80336 Munich, Germany

a r t i c l e i n f o a b s t r a c t

Article history: Autobiographical memory relies on complex interactions between episodic memory contents, associated
Received 13 September 2007 emotions and a sense of self-continuity over the course of one’s life. This paper reports a study based
Received in revised form 9 June 2008 upon the case of the patient NN who suffered from a complete loss of autobiographical memory and
Accepted 10 June 2008
awareness of identity subsequent to a dissociative fugue. Neuropsychological, behavioral, and functional
Available online 21 June 2008
neuroimaging tests converged on the conclusion that NN suffered from a selective retrograde amnesia
following an episode of dissociative fugue, during which he had lost explicit knowledge and vivid memory
Keywords:
of his personal past. NN’s loss of self-related memories was mirrored in neurobiological changes after the
Retrograde amnesia
Functional amnesia
fugue whereas his semantic memory remained intact. Although NN still claimed to suffer from a stable
Dissociative fugue loss of autobiographical, self-relevant memories 1 year after the fugue state, a proportionate improve-
Autobiographical memory ment in underlying fronto-temporal neuronal networks was evident at this point in time. In spite of this
fMRI improvement in neuronal activation, his anterograde visual memory had been decreased. It is posited
that our data provide evidence for the important role of visual processing in autobiographical memory as
well as for the efficiency of protective control mechanisms that constitute functional retrograde amnesia.
© 2008 Elsevier Ltd. All rights reserved.

1. Introduction tions. According to this theory, voluntary and involuntary forms

The ability to vividly re-experience autobiographical memo-
ries is thought to be unique to humans, reflecting an advanced
state of consciousness that mediates awareness (Tulving, 1989).
Autobiographical memory relies on complex interactions between
different memory systems as well as on interactions with associ-
ated emotions and on a sense of self-continuity across the course
of one’s life. It is characterized by emotional salience, indicat-
ing the modulating role of emotions for storage and retrieval.
The loss of autobiographical memory may occur during retro-
grade amnesia (RA) following traumatic or stressful experiences.
For example, in dissociative disorders, it can occur during or sub-
sequent to a dissociative fugue (Glisky, Ryan, Reminger, & Hardt,
2004; Markowitsch, Calabrese, et al., 1997a; Markowitsch, Fink,
Thöne, Kessler, & Heiss, 1997b). According to Kopelman (2000a,b)
RA is the result of changes in the activation of executive func-
∗ Corresponding author. Tel.: +49 89 5160 5565; fax: +49 89 5160 5562.
E-mail address: kristina.fast@med.uni-muenchen.de (K. Hennig-Fast).
of inhibition push unwanted memories out of awareness and
reduce capacity for retrieval (see also MacLeod & Macrae, 2001).
There is a trend towards discussing the inhibition of memory
retrieval as being related to functional changes in neurobiolog-
ical mechanisms which are often associated with alterations in
frontal, temporal and parietal brain activity (e.g. De Renzi &
Lucchelli, 1993; Kritchevsky, Chang, & Squire, 2004; Nakamura et
al., 2002; Papagno, 1998; Sellal, Manning, Seegmuller, Scheiber, &
Schoenfelder, 2002; Starkstein, Sabe, & Dorego, 1997; Stracciari,
Ghidoni, Guarino, Poletti, & Pazzaglia, 1994). Evidence from studies
of patients with organic amnesia suggests that visuo-spatial pro-
cessing is crucial to autobiographical recall (e.g. Greenberg, Eacott,
Brechin, & Rubin, 2005). But, up until now there has been no evi-
dence for the impact of visuo-spatial processing in psychogenic
or functional RA. However, since memories that have the quality
of being both threatening and painful, and vivid could endan-
ger the stability of an intact self-concept, they may be removed
from consciousness. This process of removal could help to main-
tain amnesia. It can be seen as a resource-consuming condition
requiring extensive executive and attentional control that mod-
ulates visual memory and imagery as well as related memory

0028-3932/$ – see front matter © 2008 Elsevier Ltd. All rights reserved.
doi:10.1016/j.neuropsychologia.2008.06.014
2994 K. Hennig-Fast et al. / Neuropsychologia 46 (2008) 2993–3005
qualities, e.g. the olfactory or acoustic pattern of a recollected
episode. From a theoretical standpoint, gaining access to memories
includes the (re-)activation of distributed, stored memory traces,
as well as strategic operations sustaining the generation process
during retrieval (Conway & Pleydell-Pearce, 2000; Moscovitch et
al., 2005; Rubin, 2005). Because autobiographical memories are
episodic memories for contextually rich events (Tulving, 1983),
varying in temporal and spatial context, emotions, visual imagery
and relation to the self, the retrieval of those memories is associ-
ated with processing in a distributed neural network (e.g. Daselaar,
Rice, Greenberg, LaBar, & Rubin, 2008; Svoboda, McKinnon, &
Levine, 2006). Apart from the prefrontal Cortex (PFC), the network
underlying autobiographical retrieval includes the medial temporal
lobe (MTL), the visual cortex, the posterior medial parietal cor-
tex and areas involved in sensory and emotional processing (for
a review see Daselaar et al., 2008). Damasio (1989) has created a
model that attempts to explain retrograde memory loss in RA in
cognitive neuropsychological terms. According to this model, the
retrieval of episodic personal memories presupposes recalling at
progressively richer levels, with the evocation of greater contextual
complexity.
Besides documenting a follow-up case of RA after a dissociatve
fugue (DF), the present study attempts to answer the following
questions: How is retrograde memory loss for autobiographical
episodes and facts related to other cognitive functions? In particu-
lar, how is autobiographical RA related to performance in visual
memory, attention and executive function? Is there a quantita-
tive and qualitative change in autobiographical memory over the
course of a year that can be related to a concurrent change in cog-
nitive functions? Can the RA be detected as neurofunctional brain
activation during functional brain imaging while performing an
autobiographical memory task? Does brain activation differ from
the typical activation pattern known to be associated with suc-
cessful retrieval of autobiographical information (i.e. Daselaar et al.,
2008)? Are specific prefrontal activation patterns related to exec-
utive and attentional functions? Are temporo–parieto–occipital
patterns related to visual imagery or vivid memory?
We predicted that a person lacking autobiographical memory
would perform comparably on retrieval of real autobiographi-
cal and retrieval of fictitious autobiographical events. We also
predicted that they would show better recall of semantically
related public events than autobiographical events. Addition-
ally, we hypothesized that this amnestic person would display
increased activation in the brain areas relevant for controlling
and monitoring of memories (e.g. prefrontal cortex, anterior cin-
gulated, insula). We also predicted that such a person would
display a decreased activation in areas for visual information
processing.
2. Case history
To our knowledge this is only the second follow-up study of a
patient with selective functional retrograde amnesia where func-
tional brain imaging was used to examine the change of cognitive
patterns and their underlying networks (first study: Repetto et
al., 2007). However, this is the first follow-up study in a patient
with preceding DF. The patient was assessed twice, once in an
acute state and 1 year post-onset. During the 1-year interval
between both assessments he suffered from adjustment problems
and was treated with both preventative antidepressive medication
and cognitive-behavioural therapy.
Patient NN was a 39-year-old right-handed male, who strayed
through streets and lanes of Southern Germany and Austria in a
state of DF that persisted approximately 2 weeks. He was first seen
by the emergency neurologist at the outpatient clinic of the Munich
University Hospital and was later admitted to the psychiatric ward
of the hospital. When first asked about memories from around the
time of fugue episode, NN reported only some vague memories of
feet walking as well as some dark silhouettes of unknown faces.
He described those visual impressions as constricted, as though
he was in a tunnel looking out. One month post-onset, in the sec-
ond examination he regained memories of several episodes and
fragments from the time of fugue. He claimed, however, to have
none of his own memories of his personal past before the DF,
e.g. of his childhood, family, school days, and career. He reported
only vague feelings of familiarity towards things, e.g. his cloth-
ing. In contrast to Schacter’s finding (Schacter, Wang, Tulving, &
Freedman, 1982) of some scattered happy memories in his patient,
NN regained only three remote and strongly negative childhood
memories dating from the time before the dissociative fugue sur-
faced over the coming months. All were highly negative, vivid and
fragmented episodes comparable to frozen images, e.g. of the coffin
at his grandfather’s funeral.
NN’s memory for implicit skills was still intact. As was his mem-
ory for public events. Interestingly, he had no awareness of his
skills, e.g. with respect to using a computer, playing a guitar and
most remarkably writing his signature. However, when asked about
public events over the last 30 years he was able to answer most
of the questions and he was fully aware of the knowledge he still
had. There was some concern that NN might be feigning his amne-
sia for reasons unknown to us. To control for this possibility, we
interviewed his family and the hospital’s medical staff for possible
inconsistencies in daily behavior. But neither his cognitive profile
nor the observed behavior provided any evidence for feigning the
amnesia.
2.1. Neurological status and brain pathology
Detailed neurological examinations revealed that NN’s neuro-
logical preamnestic status had been retained. Electroencephalog-
raphy (EEG) and electrocardiogram (ECG) examinations displayed
no pathological changes. Only an axonal sensomotoric neuropa-
thy with an increased pain perception that was already diagnosed
in 1993 was observed. All other somatosensory and motor func-
tions were normal. Organic (i.e. neurological, general medical) or
substance-related causes of RA were excluded from considera-
tion.
NN underwent conventional magnetic resonance imaging
(cMRI) and computed tomography (cCT). Cross-sectional imaging
gave no evidence for brain abnormalities. Cerebral structures were
completely normal for his age. Resting 18 F-Fluor-Desoxyglukose
(FDG)-positron emission tomography (PET) scans showed a
decreased tracer uptake of 8–15% (Fig. 1).
2.2. Psychiatric status
The patient was alcohol-dependent for about 10 years (his alco-
hol consumption varied over the years with a maximum of 4 l of
beer per day). He underwent addiction treatment that enabled him
to successfully abstain from alcohol. This took place 10 years before
the onset of the dissociative fugue. He attempted suicide three
times: twice by cutting his wrists; and a third time by starvation
after his ex-wife left him. During his treatment, his psychothera-
pists diagnosed an anxious-depressive and narcissistic personality
structure leading to emotional instability.
By the time NN was admitted to the hospital he was disori-
ented with respect to time, location, and his personal identity.
Neither a loss of consciousness nor a head injury were reported
or present at the time of assessment. His formal thinking was nor-
 K. Hennig-Fast et al. / Neuropsychologia 46 (2008) 2993–3005
Fig. 1. Decreased tracer uptake of 8–15% in the right temporo-mesial brain region of NN. Levels of significance were p < 0.001 and p < 0.05, respectively. The percent values
reflect the relatively reduced metabolism throughout the right temporo-mesial region when compared to the expected values obtained from a healthy standardization
sample. Multiple statistical comparisons were used.
mal but his mood was depressed. His affect was flattened and he
complained about pain in his legs, a feeling of agitation and amph-
icrania. But neither a clinical depression nor an anxiety disorder
could be diagnosed by means of the Structured Clinical Interview
for DSM-IV (SCID; Wittchen, Wunderlich, Gruschwitz, & Zaudig,
1996). An accessory amnestic syndrome (ICD-10, F 44.0; ICD-10,
World Health Organisation, 1992) was diagnosed irrespective of
the prior dissociative fugue (ICD-10, F 44.1).
An organic amnestic syndrome (ICD-10, F 04) caused by pro-
longed alcohol abuse was considered but was ruled out for the
following reasons. Firstly, although NN was alcohol dependent
for about one decade of his life, he had been alcohol-abstinent
for more than 10 years since then. Additionally there was no
evidence for cerebral atrophy in imaging data. Furthermore, NN
did not show any symptoms of addiction, craving or withdrawal
after admission. If NN’s condition was a result of alcohol abuse,
the damage would affect also anterograde memory functions. NN,
however, was afflicted with a selective loss of autobiography and
identity; all other memory functions remained clinically unim-
paired. Additionally, a dissociative fugue preceded the amnestic
syndrome and this is not typical for alcohol-related amnestic syn-
dromes. Finally, his amnesia did not occur exclusively during the
course of a dissociative fugue and was not due to direct physiolog-
ical effects of a substance abuse (e.g. from drugs or medication)
or a neurological or other general medical condition (e.g. head
trauma).
3. Psychiatric psychometric assessment
In order to refine the diagnosis in accordance with the ICD-
10 criteria, the Beck Depression Inventory-II (BDI-II, Beck, Steer,
& Brown, 1996), the Dissociative Experience Scale (DES, German
version: Fragebogen für Dissoziative Symptome, FDS, Freyberger,
Spitzer, & Stieglitz, 1998) and the Temperament and Character
Inventory (TCI, Cloninger, Svrakic, & Przybeck, 1993) were admin-
istered to NN.
2995
3.1. Results
Using the BDI-II, a 21-question multiple-choice self-report
inventory, NN was identified as having only minimal symptoms of
depression during the acute phase, which lasted around 2 weeks
(raw value of 13). His symptoms were significantly reduced a
few months afterwards and 1 year following onset (raw value
of 5). NN’s completed the FDS, a self-report measure that asks
subjects to indicate the frequency of different dissociative expe-
riences by considering the key aspects of the dissociation construct
(autobiographical amnesia, depersonalization, absorption, identity
alterations). This resulted in a profile with scores (uniformly) highly
above average and significantly higher than the mean scores of
patients suffering from dissociative or alcoholic disorders (NN’s
scores: amnesia score = 38.75, absorption score = 44.44, derealisa-
tion score = 48.33 and the conversion score = 24.44; for comparison:
Freyberger et al., 1998).
NN also completed the visual memory and imagery as well as
related memory qualities, e.g. the TCI, which has been proposed as a
method for investigating personality using a dimensional approach
of temperament and character. It comprises four temperament
dimensions (novelty seeking, harm avoidance, reward dependence,
persistence) and three character dimensions (self-directedness,
cooperativeness, self-transcendence). Compared to healthy con-
trols, NN showed diminished exploratory activity in searching for
novelty and sensations (percentile: 2), and an increased heritable
tendency to respond intensely to signals of aversive stimuli as well
as to avoid harm (percentile: 99).
4. General neuropsychological assessment
Cognitive measures on intelligence (revised Wechsler Adult
Intelligence Scale, WAIS-R; German version: HAWIE-R, Tewes,
1991), attention (Testbatterie zur Aufmerksamkeitsprüfung, TAP,
Zimmermann & Fimm, 1993; WMS-R, German version: Härting et
al., 2000), executive functions (Halsted Category Test, HCT, Ger-
2996 K. Hennig-Fast et al. / Neuropsychologia 46 (2008) 2993–3005

Table 1
Results of neuropsychological assessment: a comparison of NN’s performance in first examination (T1) and 1 year later (T2)

Cognitive function Instrument T1 T2 Trend

Intelligence WAIS-R: PIQ/VIQ 106/102 109/126 ≈/⇑

Attention and executive functions Attention score (WMS-R) 109 99 ≈

Tonic alertness (TAP)a 55 76 ⇑
Phasic alertness (TAP)a 55 79 ⇑
Go/No-Go/inhibition (TAP) reaction timea 79 106 ⇑
Go/No-Go/inhibition (TAP) error scorea 79 94 ⇑
Trail making test Ab <55 97 ⇑
Trail making test Bb n.a. 80 ⇑
Digit symbol coding (WAIS-R) 79 100 ⇑
Digit span (WAIS-R) 115 118 ≈
Halstead Category Test 103 105 ≈
Picture arrangement (WAIS-R) 115 115 ≈
Comprehension (WAIS-R) 94 118 ⇑
Similarities (WAIS-R) 100 133 ⇑

Anterograde memory WMS-R (German version)

VerbM/VisMQ 111/93 119/72 ≈/⇓
Immediate memory 106 104 ≈
Delayed memory 113 109 ≈
Priming (fragmented picture test) ∅ ∅ ≈

Visual perception/construction Picture completion (WAIS-R) 88 119 ⇑

Object assembly (WAIS-R) 115 124 ≈
Block design (WAIS-R) 103 115 ≈

Note: VIQ = Verbal intelligence score, PIQ = Performance intelligence score, VerbMQ = Verbal memory quotient; VisMQ = Visual memory quotient; ≈ = unchanged, ⇑ = improved,
⇓ = decreased. ∅ = at average, n.a. = not assessable. All original standard values are transformed into IQ-scores (mean = 100; standard deviation = 15).
a
The TAP subtest on alertness measures sustained attention, the subtest on selective attention is a go/no go task, measuring behavioural inhibition.
b
Norms are from Spreen and Strauss (1998) which were extrapolated from Yeudall et al. (1987) and Tombaugh et al. (1996).

man PC-Version: Fast & Engel, 2007; Trail Making Test, TMT, Reitan,
1986), and anterograde memory (revised Wechsler Memory Scale,
WMS-R, German version: Härting et al., 2000) were used to deter-
mine the degree to which NN’s general cognitive performance
differs between both times of examination. All original standard
values for both assessments were transformed into IQ-scores (see
Table 1).
We also tested NN’s implicit memory, using a fragmented pic-
ture test (German version: Fragmentierter Bilder Test, Kessler,
Schaaf, & Mielke, 1993). NN exhibited normal facilitation in this test
of visual priming in the first assessment. Thus the test was given
once only.
4.1. Results
Despite an average intelligence quotient (IQ) and a normal
abstract reasoning capacity at both times of assessment, NN’s atten-
tion, information processing speed and executive functioning were
impaired in the first examination. At the time of the first assess-
ment, his performance reflected an average ability to learn and store
new information. One year later, NN’s performance on verbal mem-
ory was above-average. In contrast, his visual memory score had
fallen by more than one standard deviation. This finding was con-
sistent with his improved superior verbal IQ at the time of retesting,
whereas his non-verbal IQ was unchanged. Additionally, 1 year after
onset, his attention, information processing speed and executive
functioning had been improved (Table 1).
5. Assessment of retrograde memory
Retrograde memory was assessed with tests of semantic and
episodic remote information. Remote memory for public peo-
ple was evaluated with the Famous Faces Test (Fast, Fujiwara,
& Markowitsch, 2007a; Fast, Fujiwara, Schröder, & Markowitsch,
2007b). Remote memory for self-related, biographical informa-
tion was tested with an autobiographical interview adapted
from Kopelman, Wilson and Baddeley (AMI, 1990; German ver-
sion: Erweitertes Autobiographisches Gedächtnisinventar: Fast,
Fujiwara, & Markowitsch, 2007a; Fast, Fujiwara, Schröder, et al.,
2007b).
5.1. Test of semantic knowledge and memory for famous faces
General knowledge was assessed with the subtest Information
from the WAIS-R. For evaluation of the temporal gradient of seman-
tic remote memory, a Famous Faces Test (FFT, Fast, Fujiwara, &
Markowitsch, 2007a; Fast, Fujiwara, Schröder, et al., 2007b) was
administered. In this test, subjects are asked to recall the correct
name and to provide additional detailed knowledge about a famous
person (e.g. nationality, profession) cued by a portrait photo. Sub-
jects are presented with portrait photos of famous popular people
from the past decades up to 2007. If the subject fails to name the
person in the photograph, he or she is asked to choose the correct
name of the famous person from a block of four names, includ-
ing fictitious names. Again, they have the opportunity to search for
semantic information about the presented person on the basis of
the name. A total of 3 blocks of 10 portraits each were presented to
NN controlling for his age at the time of assessment.
5.2. Test on self-related episodic and semantic memory
We assessed the episodic self-relevant remote memory with an
autobiographical memory inventory (German version of the Auto-
biographical Memory Interview (AMI) of Kopelman, Wilson, and
Baddeley, 1990: Erweitertes Autobiographisches Gedächtnis Inven-
tar, E-AGI, Fast, Fujiwara, & Markowitsch, 2007a; Fast, Fujiwara,
Schröder, et al., 2007b). The E-AGI consists of a semi-structured
interview dealing with facts and events in the subjects’ life during
specific periods. Subjects are required to provide five autobi-
ographical facts, two episodic incidents and details on one of
the two incidents for each period. Cues for generic events were
shown throughout the entire length of the interview (e.g. falling
 K. Hennig-Fast et al. / Neuropsychologia 46 (2008) 2993–3005
Fig. 2. Performance scores obtained by NN on the famous faces test in the first and
second assessment (time 1 and time 2).
in love/first kiss, school enrolment, birth of child) in order to aid
retrieval. Periods of 0–5 years of age, 6–10 years, 11–18 years, 19–34
years and the last 5 years prior to the onset of amnesia were tested
in NN.
5.3. Results
In the first measurement, NN exhibited no impairment in access
to general knowledge on the subtest Information of the WAIS-R. His
ability to recall names of famous people and facts about those peo-
ple was above average. His performance in the semantic knowledge
test and his memory for names and facts about public people were
equally strong in the second examination, 1 year later (Fig. 2).
At initial testing, his memory for autobiographical episodes
and facts was severely impaired. NN’s low scores for retrograde
autobiographical memory were relatively unaltered over the 12-
month period. The only improvement consisted of his being able
to remember a few fragmented episodes from childhood and some
episodes from the time of his dissociative fugue (Fig. 3).
6. Functional imaging study
6.1. fMRI paradigm
NN underwent an fMRI measurement twice, during the acute
state and 1 year after onset. His patterns of brain activation
were compared to neuronal activation in a group of eight healthy
men (mean age = 36, range of age = 30–50, mean years of educa-
tion = 11.6) who underwent a single fMRI measurement. In the
fMRI procedure we used a memory paradigm on retrograde auto-
Fig. 3. Performance scores obtained by NN on the autobiographical memory test in
the first and second assessment (time 1 and time 2).
2997
biographical episodes and retrograde public episodes. As well as
this we used fictitious scenarios and episodes similar to the real
used retrograde events. This paradigm was developed based on the
experimental procedure of Piefke, Weiss, Zilles, Markowitsch, and
Fink (2003) who has provided evidence for the sensitivity of this
method to generate activation in neuronal networks related to auto-
biographical retrieval in healthy participants (see also Daselaar et
al., 2008). Hence, we implemented an experimental design that
included two memory conditions for retrieving real public (RP)
and autobiographical (RA) memories ( = two memory conditions) as
well as two imagination conditions for visualizing fictitious unex-
perienced public (FP) and autobiographical (FA) scenarios ( = two
fictitious memory conditions).
For NN, individual stimuli were acquired by interviewing his
wife who collected different episodes of his life. Some of these were
drawn from her memory and some were collected with the help of
other relatives. For the healthy male controls the individual stim-
uli were collected by interviewing each participant 4 weeks prior
scanning. None of them were informed about the later memory test
prior scanning. Sixty different stimulus sentences were constructed
for all autobiographical episodes. In order to differentiate between
vivid remembering and pure imagination 60 stimulus sentences
constructed from fictitious, never experienced autobiographical
events expressed in the style of real autobiographical stimuli were
generated. Additionally, 60 real public events distributed over the
last four decades were collected and transformed into 60 stimulus
sentences as was done with the autobiographical cues. Again 60
similar fictitious public events were generated for comparison of
recall and imagination. Hence, a total of 60 short sentences, com-
parable in length and word order, were generated for each of the
four memory conditions: (a) real autobiographical condition (RA);
(b) fictitious autobiographical condition (FA); (c) real public con-
dition (RP); and (d) fictitious public condition (FP). This material
(240 non-identical individual stimulus sentences in total) was used
during the fMRI experiment to trigger the associated autobiograph-
ical and public memories. There was no repetition of the individual
stimulus sentences, either within or across the experimental condi-
tions. This was done in order to avoid potential habituation effects.
Prior to scanning, NN and the control subjects were familiarized
with the experimental set-up and the tasks.
Presentation and timing of stimuli was accomplished using
Presentation® software (Version 0.80, built on 13.02.2004). Inside
the MR scanner, NN viewed the stimuli over a head-coil compatible
mirror system (300 cm screen to mirror, 15 cm mirror to subject’s
eyes). Stimuli were projected on a translucent screen in white capi-
tals on black background by a commercially available video beamer
(INTouch, resolution of 1024 × 768 pixel) protected by a Faraday
cage.
A factorial-blocked design was applied to evoke the neural
responses associated a) with retrieval of different types of mem-
ory content (autobiographical, public) and b) with real retrieval
compared to imagination (real, fictitious). Six individual trials of
one of the four experimental conditions (e.g. real autobiograph-
ical memory) were blocked together. Each trial consisted of the
stimulus sentence that should trigger autobiographical episodes
(presented for 5 s) 5 s and an interstimulus interval (ISI) of 100 ms.
Thus, each block of trials lasted 30.6 s. The complete experimental
paradigm consisted of two repeated blocks of one memory/imagery
condition. The order of blocked conditions (RA, FA, RP, FP) was coun-
terbalanced across five runs (run1: EI RA FA RP FP EI FP RP FA RA;
run2: EI FA RA FP RP EI RP RA FA FP; run3: EI FA FP RP RA EI RP
FP RA FA; run4: EI RA RP FP FA EI FA RP FP RA; run5: EI RP FA FP
RA EI FP RA RP FA.) The experimental instructions (EI) lasted 30.6 s
and were repeated at the beginning of each new run and after four
blocks within each run in order to use it as baseline for statistical
2998 K. Hennig-Fast et al. / Neuropsychologia 46 (2008) 2993–3005

Fig. 4. The experimental task consists of four conditions presented in a block design. The blocks were separated by a break. The order of the four conditions was counterbalanced
across all runs. The design is exemplified by the RA and RP condition.

comparison. Activation blocks were separated from each other by size, 1.05 mm × 1.05 mm, field of view, 270 mm, matrix, 224 × 256,
fixation crosses each lasting 3 s (see Fig. 4). Instructions were as numbers of slices, 128.
follows: ‘Please remember all presented events specified in the
displayed sentences as vividly as possible.’
6.3. Image and statistical analysis

6.2. fMRI data acquisition
Functional MRI images were collected with a 1.5 Tesla
scanner (Magnetom Vision, Siemens Erlangen, Germany) using
T2*-weighted BOLD (blood oxygen level dependent) sensitive
echo planar imaging (EPI) sequences (echo time, 60 ms, rep-
etition time, 3600 ms, flip angle = 90◦ , slice thickness = 4 mm,
inter-slice gap = 0.25 mm, field of view, 240 mm, in plane resolu-
tion, 3.75 × 3.75 mm, matrix = 64 × 64). Twenty-eight transversal
slices (slice thickness 4 mm) from the cerebellum to the cortex were
acquired parallel to the anterior commissure–posterior commis-
sure (AC–PC) in interleaved order.
For visualization of the functional data, high resolution anatomi-
cal images (3D MPRAGE, magnetization-prepared rapid acquisition
gradient echo) were recorded following the functional measure-
ments with following parameters: echo time, 4.4 ms, repetition
time, 11.4 ms, flip angle = 8◦ , effective slice thickness, 1.25 mm, pixel
Imaging data were analyzed with BrainVoyager QX (Goebel,
2006). The first three scans were excluded from data analysis to
minimize T1 effects. The functional images were 3D motion and
slice scan-time corrected using sinc-interpolation. The anatomi-
cal data were normalized into a standard Talairach template for
each healthy participant and NN separately. Finally the functional
data were co-registered with the individual 3D anatomical data of
each participant. Differences between the experimental conditions
were assessed voxel by voxel over the conditions using random
effects analysis which is based on a general linear model. The visu-
alized fMRI results are due to BOLD contrasts which were analyzed
using the subtraction method between the different experimen-
tal conditions (e.g. RA minus FA). In this voxel-based approach,
contrast maps were computed for the predictors RA minus FA,
RA minus. RP, RP minus FP, and vice versa. Standard stereotac-
tic coordinates of pixels showing local maximum activation were
determined within areas of significant relative changes in neural

Fig. 5. Significant clusters of activation in response to the contrasts of real autobiographical memory condition against fictitious autobiographical imagination condition: (a)
of NN in the first measurement: RA > FA: BA 25/32; (b) of NN in the second measurement: RA > FA: BA 11/13; BA 35/38/20/21 and (c) of healthy controls: RA > FA: BA 37/38,
BA 46/47, BA 18/20 (threshold: uncorrected p < 0.01).
 K. Hennig-Fast et al. / Neuropsychologia 46 (2008) 2993–3005 2999

Table 2
NN’s brain regions activated in response to contrasts of different experimental conditions during the first fMRI-measurement (p < 0.01, uncorrected for multiple comparisons,
extent threshold 50 voxels, balanced)

Region Talairach co-ordinates (in mm)

BA Left Right

X, Y, Z z-value X, Y, Z z-value

Real autobiographical > fictitious autobiographical

Posterior cingulate 30 −9, −55, 10 3.46
Subcallosal gyrus 25 −6, 23, −14 3.76
Real autobiographical > real public
Anterior cingulate 32 −9, 44, −5 3.81
Posterior cingulate 30 −9, −55, 10 3.94
Precentral gyrus 6 30, 5, 31 3.48
Real public > fictitious public
Mesial frontal gyrus 10 18, 47, −5 3.39

Note: Coordinates of voxels are presented in Talairach and Tournoux space (z-value refers to peak of activated cluster); BA = Brodmann area.

activity associated with the demands of the different experimental
conditions. These local maxima were anatomically localized by ref-
erence to a standard stereotactic atlas (Talairach & Tournoux, 1988)
(Fig. 5).
6.4. Experimental fMRI results: first measurement during the
acute state
The Brain Voyager analysis conducted on the whole brain did
not find activation in our a priori regions of interest during auto-
biographical retrieval during the acute state. Direct comparison
between the real autobiographical memory and fictitious auto-
biographical memory showed that the left sub-callosal and the
left cingulate were more active during the condition of autobi-
ographical memory than when attempting to retrieve fictitious
events. Relative to the public memory task (RA minus RP), para-
metric effects of self-relevance of remembering were revealed in
only left cingulate regions and the superior frontal gyrus. Activa-
tion was found in the mesial frontal gyrus for the contrast of real
public memory (RP) minus fictitious public memory (FP). Results
of the conjunction analysis performed on the reverse comparison
(FA > RA; RP > RA, FP > RP) yielded no activation, using the same

Table 3
Brain regions activated in response to contrasts of different experimental conditions during the second measurement after 1 year (p < 0.01, uncorrected for multiple
comparisons, extent threshold 50 voxels, balanced)

Region Talairach co-ordinates (in mm)

BA Left Right

X, Y, Z z-value X, Y, Z z-value

Real autobiographical > fictitious autobiographical

Mesial frontal gyrus 11 36, 38, −8 4.53
Insula 13 −42, −19, −8 4.82 21, −4, 7 4.52
Anterior cingulate 24 9, 23, 1 4.68
Parahippocampal gyrus 35 −27, −25, −26 5.07
Superior temporal gyrus 38 −42, 26, −23 4.88
Superior temporal gyrus 22 −51, −25, −2 5.37
Inferior temporal gyrus 20 −52, −7, −38 5.44
Fusiform gyrus 20 −42, −28, −17 5.03

Fictitious autobiographical > real autobiographical

Superior frontal gyrus 9 −12, 44, 50 3.96
Superior frontal gyrus 6 18, 18, 64 4.32
Mesial frontal gyrus 8 27, 41, 43 4.46
Superior temporal gyrus 38 −33, 8, −32 5.21
Real autobiographical > real public
Insula 13 −45, 5, 1 3.39 27, 25, 13 3.74
Middle frontal gyrus 11 −21, 50, −8 3.74 36, 44, −11 3.57
Inferior frontal gyrus 47 39, 26, 4 3.75
Extra nuclear/sub-lobar gyrus 47 30, 17, 1 3.77
Precentral gyrus 6 −64, −7, 31 3.77
Cingulate gyrus 24 −9, 7, 28 4.02
Real public > real autobiographical
Inferior frontal cortex 47 −21,11, −17 4.21
Fusiform gyrus 20 42, −22, −11 3.36
Inferior temporal gyrus 21 60, −7, −17 3.44
Middle temporal gyrus 21 60, −19, −5 3.48
Subgyral (temporal lobe) 21 42, −16, −14 3.41
Mesial frontal gyrus 25 12, 31, −14 4.55
Anterior Cingulate 32 12, 32, −14 3.70
Real public > fictitious public
Mesial temporal gyrus 21 51, 8, −32 3.79

Note: Coordinates of voxels are presented in Talairach and Tournoux space (z-value refers to peak of activated cluster); BA = Brodmann area.
3000 K. Hennig-Fast et al. / Neuropsychologia 46 (2008) 2993–3005

thresholds (p < 0.01, uncorrected for multiple comparisons, cluster- poral activation was found when fictitious public memory (FP) was
level k > 50 voxels; see Table 2). subtracted from public memory (RP).

6.5. Experimental fMRI results: second measurement 1 year after 6.6. Comparison of the activation pattern during acute state and
onset 1 year after onset

The comparison between the real autobiographical memory
(RA) and the fictitious memory (FA) condition revealed increased
activation in an extensive mainly left-hemispherically distributed
network including the left parahippocampus and frontal and
temporal lobe (Table 3). This contrast yielded activations in the
following temporal regions: left inferior and superior temporal
gyrus and the left fusiform gyrus. Furthermore, this comparison
yielded evidence of activation in the left superior frontal gyrus and
the right cingulate gyrus. In addition, the bilateral insulae showed
increased activity associated with the autobiographical condition
in NN (Table 3). The retrieval of self-related memories contrasted
against public memories was associated with activation in a bilat-
eral anterior network within frontal brain regions: right sub-lobar,
right superior and inferior frontal gyrus, bilateral mesial frontal
gyrus, the left cingulate and precentral gyrus, and left insula. The
reverse contrasts resulted in activations within separable cerebral
networks: FA > RA was associated with frontal activation, RP > RA
involved only temporal regions, see Table 3). A single mesial tem-
NN’s responsive patterns during the first measurement were
restricted in terms of activations within anterior frontal brain
regions, whereas the activated networks during the follow-up mea-
surement were more differentiated (Tables 2 and 3). One year after
onset NN showed additional clusters of activation in regions that
are known to be crucial for autobiographical memory: the parahip-
pocampus and the temporal lobe. However, he did not display
this additional temporal activation when autobiographical mem-
ory was contrasted with public memory (RA minus RP). The reverse
contrast revealed a temporal activation in the right hemisphere in
response to public events.
The statistical comparison of time of follow-up and time of
onset, however, resulted in clusters of increased activation in the
temporal, limbic and frontal lobes in response to autobiograph-
ical stimuli. Elevated activation was found within a network of
the following temporo–limbic regions: the medial, superior, infe-
rior, fusiform temporal gyrus and the right parahippocampal gyrus.
Additionally, the left inferior frontal gyrus was responsive to autobi-

Table 4
Brain regions activated in response to contrasts of the two times of measurement (follow up minus first measurement, and vice versa) for the main experimental conditions

Region Talairach co-ordinates (in mm)

BA Left Right

X, Y, Z z-value X, Y, Z z-value

Real autobiographical at follow up > first assessment

Inferior frontal lobe 47 −43, 22, 6 4.03
Middle temporal gyrus 21/22 −64, −40, 0 3.74 49, −40, −2 3.91
21 −61, −30, −1 3.27
Inferior temporal gyrus 20 −58, −39, −15 3.16
Fusiform gyrus 37 −51, −58, −17 4.12
20 −39, −31, −14 3.70
Parahippocampal gyrus 36 41, −33, −11 3.30
Real autobiographical at first assessment > follow up
Middle frontal Cortex 10 −29, 47, 8 4.37 39, 45, −2 4.31
Inferior frontal Cortex 47 −18, 23, −16 3.88 31, 31, −15, 3.43
Anterior Cingulate 32 −17, 23, 17 4.23
Insula 13 42, −16, 24 3.44
Parahippocampal gyrus 37 −9, −21, −11 3.90
Superior temporal lobe 39 41, −56, 24 3.38
38 36, 14, −28 5.11
Cuneus 30 −9, −58, 10 4.97
Real public at follow up > first assessment
Subgyral temporal gyrus 20 39, −19, −16 3.71
Middle temporal gyrus 21 57, −37, −2 3.65
Superior temporal gyrus 22 48, −22, −5 4.78
Fusiform gyrus 37 −49, −36, −10 3.36
Cuenus 18 −15, −100, −2 3.69
Real public at first assessment > follow up
Superior and middle frontal gyrus 6 −10, 33, 55 3.64 25, −1, 60 3.75
Middle frontal gyrus 46 −47, 38, 17 4.18
9 40, 11, 26 4.39
Paracentral gyrus/ 6 −9, −22, 52 4.16
Precentral gyrus 6 51, −1, 22 3.98
Middle frontal gyrus 11 36, 38, −8 4.53
Insula 13 42, −13, 23 3.99
Cingulate gyrus 32 −14, 20, 39 4.51
Posterior cingulated 31/29 −9, −65, 17 3.88 3, −43, 10 4.62
Hippocampus 32, −16, −14 3.91
Parahippocampal region 30 7, −38, 5 4.11
Inferior parietal lobule 40 47, −28, 29
Fusiform gyrus 19 36, −69, −7 4.50
Cuneus 19 2, −94, 24 3.38
Lingual Gyrus 17 18, −85, 2 3.56

Note: Coordinates of voxels are presented in Talairach and Tournoux space (z-value refers to peak of activated cluster); BA = Brodmann area.
 K. Hennig-Fast et al. / Neuropsychologia 46 (2008) 2993–3005 3001

ographical stimuli. The converse comparison resulted in extended
activation within a network of frontal, temporal, limbic and occip-
ital brain regions (Table 4). NN activated bilateral orbitofrontal and
dorsolateral prefrontal regions, the right posterior cingulate, the
insula, the left parahippocampal gyrus, the right superior temporal
gyrus and the left cuneus.
When comparing the neural response to real public stimuli in
the follow-up examination with time of onset, an extensive acti-
vation was evident in the bilateral superior, right mesial and left
fusiform temporal lobe as well as in the left cuneus (see Table 4).
The converse contrast demonstrated extensive activation, in the
hippocampal as well as parahippocampal, parietal and occipital
regions. The anterior network included the left precentral gyrus,
right medial frontal gyrus and right paracentral lobe, the bilat-
eral dorsolateral prefrontal, the right ventromedial cortex, the right
insula, the left cingulate gyrus and the bilateral posterior cingu-
lates. The posterior network consisted of the right inferior parietal
lobule and occipital regions, right fusiform gyrus, right cuneus and
right lingual gyrus. The temporo–limbic activations were found in
the hippocampus, the right parahippocampal region and the right
medial temporal lobe.
6.7. NN’s activation pattern in comparison with activation
patterns of healthy controls
Relative to the brain activation of healthy male controls, NN’s
responsive activation was limited to anterior frontal brain regions
in all memory conditions during the first measurement (compare
Tables 2 and 5). During the second measurement NN’s network of
activation was still different to those of the control subjects, even if
it was more distributed than during the first measurement. In con-
trast to the fictitious autobiographical condition NN’s responsive
neural networks recorded during the real autobiographical condi-
tion included the bilateral insulae and the parahippocampal gyrus,
while other brain regions overlapped with those of healthy men.
When RA was contrasted against the RP condition NN still displayed
a response of anterior frontal brain regions after the 1 year delay,
while the healthy subjects’ response for this contrast involved
temporo–occipital regions (for comparison: Tables 3 and 5). In gen-
eral NN’s activation pattern did not show the posterior occipital
activations displayed in the healthy sample.
The reverse contrasts of FA minus RA, RP minus RA and FP minus
RP yielded no pattern of activation in the healthy control sample.
7. Discussion
Similarly to previous cases of RA and dissociatve amnesia (e.g.
Campodonico & Rediess, 1996; Markowitsch, Calabrese, et al.,
1997a; Markowitsch, Fink, et al., 1997b; Kopelman, Christensen,
Puffett, & Stanhope, 1994; Kritchevsky et al., 2004; Schacter et al.,
1982) the patient NN displayed an all-inclusive loss of biographical
memory and identity but intact semantic knowledge about facts
and time-related public events. Although no brain abnormality
was detected by conventional electrophysiological investigations
and high-resolution structural neuroimaging, NN exhibited a slight
temporal hypometabolism in resting state FDG-PET, pointing to
possible diffuse disturbances of brain functions underlying the RA
in his case. Concurrent to the possible neurofunctional origin of his
amnesia the most obvious psychological indication was the pre-
vious fugue state, but beyond this, his biography was marked by
diverse aversive experiences of clinical relevance (see case report).
The findings in the formal clinical and neuropsychological assess-
ment and the functional imaging data supported our argument,
which will be outlined below.
A central finding is that during his acute state the
temporo–occipital part of the network known to be related
to autobiographical memory was not activated. Instead, autobi-
ographical stimuli were associated with activation of the dorsal
anterior and posterior cingulate gyrus, the precentral and sub-
callosal gyrus as well as of the medial frontal lobe. The cingulate
gyrus functions as an integral part of the limbic system, which
is involved in emotion formation and processing, learning, and

Table 5
Brain regions activated in response to autobiographical and public memory in healthy male controls (n = 8, mean age = 36, range of age: 30–50, mean years of education: 11.6)

Region Talairach co-ordinates (in mm)

BA Left Right
X, Y, Z z-value X, Y, Z z-value

Real autobiographical > fictitious autobiographical

Inferior frontal gyrus 46 −39, 32, 8 5.57
Inferior frontal gyrus 47 −24, 23, −9 4.14
Anterior cingulate 32 −12, −55, 10 4.41
Inferior temporal gyrus 37 −60, −58, −8 5.33
Superior temporal gyrus 38 −39, 20, −20 4.96
Mesial temporal gyrus 21 51, 5, −26 4.12
Mesial temporal gyrus 21 48, −22, −11 4.55
Fusiform gyrus 20 −51, −22, −21 5.05
Fusiform gyrus 20 −39, −22, −21 4.36
Fusiform gyrus 20 39, −19, −23 4.90
Lingual gyrus 18 −12, −55, 10 4.53
Inferior occipital gyrus 17 −27, −97, −8 5.75
Inferior occipital gyrus 17 21, −97, −8 4.79
Real autobiographical > real public
cingulate 23 −9, −55, 16 3.76
Superior temporal gyrus 38 −39, 20, −20 4.04
Mesial temporal gyrus 21 −57, −19, −8 4.26 48, −22, −1 4.03
Inferior occipital gyrus 18 −31, −88, −17 4.12 36, −85, −11 3.95
Mesial occipital gyrus 18 −46, −76, −14 4.26
Lingual gyrus 18 15, −88, −17 5.51
Real public > fictitious public
Anterior cingulate 32 0, 41, −8, 3.60
Fusiform gyrus 18 18, .88, −14 3.60
Inferior occipital gyrus 18 −27, −85, −18 3.99 36, −88, −8 3.68

Note: Coordinates of voxels are presented in Talairach and Tournoux space (z-value refers to peak of activated cluster); BA = Brodmann area.
3002 K. Hennig-Fast et al. / Neuropsychologia 46 (2008) 2993–3005
memory. The executive control function needed to suppress inap-
propriate unconscious priming is known to involve the anterior
cingulate gyrus which is bounded by the agranular frontal BA6
and the frontopolar BA10. Dorsomedial frontal/anterior cingulate
cortex and posterior cingulate cortex/precuneus are also known
to be active during self-reflection (Johnson et al., 2006). Thus, this
finding indicates that NN activated self-reflective and monitoring
processes in response to autobiographical stimuli at time of onset.
On the other hand this finding is probably the result of a failure in
vivid remembering (for comparison: Daselaar et al., 2008). When
contrasting the real public condition to the real autobiographical
condition we found only medial frontal activation (BA10). This
finding can be explained by either a general loss of brain activation
at time of first assessment, probably caused either by the prior
state of dissociative fugue (e.g. a form of deficiency syndrome as
a result of walking for about 2 weeks), or by the theoretical and
neurophysiological overlap of both retrieval conditions. Public
events and autobiographical events share some features since
both are related to time and space. Semantic memory and general
autobiographical knowledge seem to permeate much of our auto-
biographical recollections. Moreover, specific incidents contain
numerous personal or general semantic representations related
to the recollected environment (e.g. people or broader public
events, etc.), that, in combination with other factors (e.g. personal
relevance or emotional relevance), allow us to form an episodic
autobiographical memory.
Thus, the retrieval of both forms of events should involve to some
extent the same neural network. In functional RA it could be that
this overlapping neural network is not activated, not only because
of organic but also because of psychogenic reasons, e.g. to prevent
a triggering of covered memories and to hold up the inhibitory
state. The substantial overlap in neural activation in response to
episodic and general semantic tasks (e.g. in the lateral temporal cor-
tex, as well as the extended semantic memory network including
the ventrolateral prefrontal cortex, temporoparietal junction, ante-
rior cingulate and cerebellum; for review: Martin, 2001) may reflect
both substantial semantic representation within the AMs retrieved
and the contribution of domain-general processes (e.g. executive
functions) that serve diverse cognitive and memory functions (see
Cabeza & Nyberg, 2000).
In the similar vein, recent studies of self-referential process-
ing have reported activation in medial frontal regions (BA9, 10)
when self-referential or internally orientated processing is manip-
ulated (e.g. Gusnard, Akbudak, Shulman, & Raichle 2001). When we
assume that NN had to decide whether this stimulus is self-related
the activation of BA10 in NN at time of first assessment might reflect
such self-referential processing during condition RP.
One year later temporo–limbic brain regions were responsive
to autobiographical stimuli. Additionally, we found bilateral acti-
vation of the insulae, a structure that is involved in the perception
of pain and somatic regulation of emotions. When calculating the
statistical comparison of neural response at the time of onset
and the time of follow-up for each separate experimental con-
dition, we found an unexpected temporo–limbic activation in
response to autobiographical stimuli at time of first assessment.
This occurred in spite of the already reported frontal brain acti-
vations. This puzzling result indicates a form of temporo–limbic
neural responsiveness at the time of onset. Nevertheless, when
compared either to brain activation related to autobiographical
stimuli at time of follow-up or responsive brain areas to pub-
lic stimuli at time of onset or to brain activation of the healthy
controls, this temporo–limbic activation is limited. In general, we
found only fusiform activation (occipito–temporal area 37/inferior
temporal area 20) but any occipital brain activation in NN dur-
ing the autobiographical condition. Since occipital activation was
found during the public condition, the lack of activation during
autobiographical retrieval could not indicate a general deficit in
perceptual experience. Nevertheless, because successful retrieval
depends on simultaneous neural activity in multiple brain regions
this lack of occipital response could reflect a failure of integration
of spatial, temporal, visual, emotional and self-related features of
one experienced episode during the attempted retrieval (Damasio,
1989). The lack of neural activation when public memory is con-
trasted with autobiographical memory in healthy controls may be
due to an overlap of both memory tasks, since both conditions
require the retrieval of information which is bound to space and
time.
In line with most prior studies on autobiographical memory,
we found a preponderance of left-hemispherical activation in NN
during autobiographical memory retrieval in both examinations
(Gusnard et al., 2001; Svoboda et al., 2006). Nevertheless, in the
second examination the responding network was more bilaterally
distributed (in accordance with Levine et al., 2004; Markowitsch,
Vandekerckhove, Lanfermann, & Russ 2003).
A second central finding in this study relates to NN’s general
cognitive performance. Attentional and executive functions that
were initially impaired during the acute phase improved over
time. While self-related retrograde memory remained impaired
and anterograde visual memory deteriorated further. A few previ-
ous studies on RA patients that investigated these functions in detail
found attentional and executive deficits underlying the amnes-
tic syndrome (Campodonico & Rediess, 1996; Glisky et al., 2004;
Stracciari et al., 1994). Others found visual deficits influencing auto-
biographical retrieval (Greenberg & Rubin, 2003).
Here, in accordance with previous cases, e.g. Kritchevsky et
al. (2004), our patient’s anterograde memory was only slightly
impaired during the first assessment but – in contrast to these
prior cases – at the time of retesting it was found be progressively
selectively impaired for visual stimuli. NN’s selective impairment in
visual episodic anterograde memory resembles the one described
in MS, a patient with extensive damage in the occipital and tempo-
ral lobes (Greenberg et al., 2005). Greenberg et al. (2005) assumed
that the destruction of visual cortices disrupts the spread of acti-
vation that autobiographical memory retrieval requires. The term
of “visual-memory deficit amnesia (VDMS)” established by Rubin
and Greenberg (1998) refers to the assumption that the disrup-
tion in recruitment of visual brain regions has the effect that other
sensory percepts and knowledge are no longer elicited.
If this is correct, a visual memory deficit could account for defi-
cient autobiographical memory in NN as well. We suggest that
visual imagery plays a central role in the recall of autobiograph-
ical memories and that anterograde visual memory impairment
may be crucial for the perpetuation of RA (e.g. Greenberg &
Rubin, 2003). Considering three aspects of NN’s amnestic pro-
file, (a) the increasing deficit in visual anterograde memory over
time, (b) the irreversibility and selectivity of RA, and (c) the
only proportionate retrieval-related increase of brain activity over
time (with a lack of enhancement within the visual cortices), we
think that an impairment in visual processing may be crucial for
the long-term persistence of NN’s loss of autobiographical mem-
ory.
Behavioral studies have shown that the best predictor of the
degree of experienced reliving is the visual imagery (Brewer, 1995;
Rubin, 2006; Rubin, Schrauf, & Greenberg, 2003) and the visuo-
spatial processing (Gilboa, Winocur, Grady, Hevenor, & Moscovitch,
2004; Greenberg et al., 2005; Teng & Squire, 1999). On the one
hand, long-term visual representations may enable the retrieval
of memories through the imagination of detailed visual features
present at the time of encoding. On the other hand, the visual
representations themselves may re-activate non-visual percepts,
 K. Hennig-Fast et al. / Neuropsychologia 46 (2008) 2993–3005
self-relevant (knowledge based) concepts as well as emotional and
visceral states related to certain past episodes (Gardini, De Beni,
Cornoldi, Bromiley, & Venneri, 2005; Gardini, Coronoldi, De Beni, &
Venneri, 2006; Intons-Peterson & McDaniel, 1991, see for “knowl-
edge based” images). If this is true, a failure in visual imagery or
visual retrieval may also distort the sense of reliving for NN. The
impaired activation in the visual cortex could impede the activa-
tion in non-visual cortices even if the non-visual cortices are intact.
In NN, for example, the recollection of the funeral of NN’s grandfa-
ther might involve generating different flexible visual scenarios and
populating it with other non-visual percepts that refer to the over-
all scenario. NN, however, recollected a fragmented frozen image.
In comparison to VDMA his fragmented memories did not involve
sounds, smells, tastes or tactile sensations.
If a neurofunctional interaction of memory and imagination
exists (Sakai & Miyashita, 1994), it can be concluded that a primary
defect in imagery impairs the ease of recall of episodic memories
and the specificity of autobiographical memory (e.g. Gardini et al.,
2006; Guralnik, Schmeidler, & Simeon, 2000, see also Damasio,
1989). This after-effect may lead to a greater sense that the world,
the people and parts of the self are strange and unfamiliar for NN, a
phenomenon that is well known in dissociative disorder and post-
traumatic stress disorder.
However, compared to prior cases of organic RA our case did
not meet the full criteria of either VMDA or a RA caused by
the damage of the MTL and the hippocampus. Consistent with
patients with VMDA, our patient suffered from only mild (dur-
ing second measurement moderate) selective anterograde amnesia
for visual stimuli. Moreover, NN did not show sparing of child-
hood memories (in the first examination). NN’s ungraded RA for
self-related memories is reminiscent of cases that probably com-
prise a parieto–occipital brain damage (e.g. Kapur et al., 1996).
However, in contrast to several VDMA cases, his retrograde mem-
ory for autobiographical facts was also severely impaired. At the
same time, his retrograde memory for episodes and facts that
were not related to his person was almost normal. Two phe-
nomenological properties play a key role in autobiographical
memory, distinguishing it from other forms of memory retrieval.
The first is the extent to which a memory is recollected, e.g.
reliving and reexperiencing as opposed to a feeling of familiarity.
According to Tulving (2002) vivid recollection is a defining fea-
ture of episodic memory: expressed in terms of traveling back in
time and in detailed spatio-temporal detail information. The abil-
ity to mentally travel back in time during reexperience of past
events is thought to depend on frontal lobe structures. Hence,
intact prefrontal functioning is seen to be associated with suc-
cessful autobiographical recollection (Moscovitch & Melo, 1997;
Konishi, Wheeler, Donaldson, & Buckner, 2000; Wheeler & Buckner,
2004), while impaired executive control and prefrontal pathology
are known to be associated with dysfunctional autobiographical
retrieval (e.g. Bright et al., 2006; Svoboda et al., 2006). Furthermore,
activity in posterior cortices, especially visual areas (e.g. Kosslyn,
Ganis, & Thompson, 2001) are assumed to be involved in vivid
recollection which is associated with a high degree of subjective
reliving.
A second phenomenological property that is important in the
retrieval of personal memories is emotional intensity (for review
Talarico, LaBar, & Rubin, 2004). Several neuroimaging studies have
shown that the functional interactions between the amygdala
and hippocampus during encoding predict subsequent memory
retrieval (e.g. Dolcos, LaBar, & Cabeza, 2004). Less is known about
the role of emotions during retrieval. Some neuroimaging stud-
ies provided support for the perspective that basic emotions act
as an early warning system, preparing the (human) organism for
fast, adaptive actions in probably life-threatening situations. Thus,
3003
emotions should be at hand even before a situation is fully com-
prehended or a memory is fully retrieved. However, other studies
suggest a modulating frontal brain system (dorsal and ventral
aspects of the mesial PFC) that differentially regulates neuroen-
docrine and autonomic hormonal outputs in immediate response to
emotional stress (e.g. Radley, Arias, & Sawchenko, 2006). Recently
theories, posit that the insular cortex is thought to be addition-
ally important for the detection of aversive somatic reactions
with a predictive value for prospective behavior (Paulus, Rogalsky,
Simmons, Feinstein, & Stein, 2003). Moreover, the representation of
interoceptive, precognitive aspects of self-knowledge and of multi-
modal aspects of visual memory may be reflected in amydgdaloid
and insular activity during retrieval (Craig, 2002, 2004). The insula’s
role in processing affective visual and somatic stimuli may also be
meaningful for the interpretation of NN’s unsuccessful attempts at
vivid remembering.
Considering three different aspects of NN’s amnestic profile, (a)
the selectivity of RA for self-related memories, (b) his elevated
scores for dissociation and harm avoidance and, (c) the bilateral
activation of the insulae and the predominant frontal activation
when contrasting autobiographical memory against public mem-
ory during the second measurement, we think that preserving the
integrity of internal body states and the elimination of “risky feel-
ings, memories and imaginations” may play a further role in the
persistence of NN’s loss of autobiographical memory.
As already proposed by Schacter et al. (1982) and Kopelman
(2000a,b) a self control entity that differentiates between
self-relevant, self-insignificant, self-consistent as well as self-
threatening memories is necessary to understand these phenom-
ena.
Schacter et al. (1982) already suggested that the scattered
episodic memories (“islands”) in his patient PN can be charac-
terized by a positive affective valence. Thus, he proposed that
functionally, RA may be primarily organized along affective, rather
than temporal dimensions. Taking this perspective, the posited
self-control entity may become operative as a protective mecha-
nism to avoid harm by fending off aversive memories. However,
unlike Schacter’s patient, NN had a spontaneous selective access
to three aversive (negative and arousing) mnestic “islands” from
childhood. If the task of remembering an autobiographical event
requires the decision in favor of a “risky” response, because of
the possibility of retrieving harmful memories, NN could have
attempted to keep these “risky” memories away from conscious-
ness. Instead he failed in some moments for reasons that are
outlined below. However, following Stein, Simmons, Feinstein,
and Paulus (2007) we can assume that NN’s general mental pro-
file is characterized by a reduced emotional resilience and an
increased physiological reactivity to aversive stimuli. His resilience
could have activated the self-regulative processes as posited in
other cases of functional RA (e.g. in PN). It is likely however,
that NN was not successful in modulating the emergence of
memories by means of attentional control. For his biography, we
conclude, that NN developed a life long sensitivity to interper-
sonal conflicts. According to Dorahy (2006) this resilience towards
stressful conflicts depends on an alteration in mental organiza-
tion that underlies a dissociative psychopathology. This alteration
affects particularly selective attention processing that serves as
a threat monitoring system. If this is the case, then the cogni-
tive inhibition that results from a stressful experience could be
weakened. Suppressed memories could resurface in these condi-
tions. This weakened cognitive inhibitory control may explain NN’s
spontaneous recollection of aversive memories. Autonomously
erupting somatic responses to autobiographical stimuli could have
led to an inefficient prefrontal control which was replaced by
a somatic, affect-related control system (that is reflected in the
3004 K. Hennig-Fast et al. / Neuropsychologia 46 (2008) 2993–3005
bilateral activation of the insulae during the second measure-
ment).
Our findings converge to suggest a fronto-subcortial modulat-
ing system and participation of the visual cortices in this persistent
RA after a dissociative fugue. This is not completely consistent to
prior cases and models of isolated retrograde amnesia (e.g. Levine
et al., 1998; Kopelman, 2000a,b), which posited a right frontal
dysfunction (and fronto-temporal disconnection) underlying the
loss of self-related (autonoetic) awareness. The findings are rather
in accordance with a recent hypothesis on the role of visual and
emotional properties in autobiographical retrieval (Daselaar et al.,
2008).
However, the interpretation of our findings is limited by all
restrictions of single case reports. When discussing several issues
raised by our case study, it should be noted that we are well aware
that data deriving from a single subject require interpretative cau-
tion. Thus we emphasize the usefulness of this study in generating
hypotheses for further studies of the characteristics of functional
RA. One further limitation is the fact that we could not prevent a
re-encoding between both assessments, i.e. through viewing pho-
tos or visiting places. This could limit the explanatory power of our
speculations about the role of defensive mechanisms.
8. Conclusion
The present case provides some insights into new aspects of
the phenomenology of autobiographical memory in selective RA.
Attentional and executive impairments are already recognized as
properties of acute RA. Our findings highlight the additional role of
visual and emotional properties of autobiographical memory in the
maintenance of RA. We provided evidence for an extensive neural
hypoactivity within the known network producing autobiographi-
cal memory retrieval. Our findings can be explained by a part-time
dysfunction of the PFC and a simultaneous predetermined or
learned hyperreactivity of anxiety-related brain structures. This
dysregulation within the system of affective and behavioral regula-
tion may be caused by disruptions within an underlying distributed
cortico–limbic network. However, even though NN’s brain activ-
ity had returned to a relatively normal level of functioning, we
found lingering impairments in anterograde visual memory and
persistent autographical retrograde amnesia. Therefore, we posit a
protective defence mechanism caused by neuronal inhibition that
served to prevent an overflow of intensive aversive emotions. Fur-
ther, we posit an impairment of visual information processing that
was the result of disruptions within the temporo–occipital neu-
ronal network. Both inhibitory impairments could have reduced
the triggering of multi-modal memory traces of visual and other
percepts, and hence, impeded a reactivation of vivid, aversive mem-
ories. Nonetheless, the persistence of NN’s amnesia in spite of his
comparatively strong neural recovery is puzzling and invites mul-
tiple possible interpretations. Further longitudinal functional brain
imaging studies in patients with dissociative or functional RA are
needed to help us to understand the interaction between the psy-
chological and neural patterns in persistent RA.
Acknowledgments
We are grateful to Calum Anderson, Sandra Dittmann and James
Moran for proofreading this paper. Further, we would like to thank
NN for his patience and interest, his relatives for their support. This
study has been approved by the medical ethic committee of the
LMU and has therefore been performed in accordance with the
ethical standards laid down in the 1964 Declaration of Helsinki.
References
Beck, A. T., Steer, R. A., & Brown, G. K. (1996). Manual for the Beck Depression Inventory-
II. San Antonio, TX: Psychological Corporation.
Brewer, W. F. (1995). What is recollective memory? In D. C. Rubin (Ed.), Remember-
ing our past: Studies in autobiographical memory. (pp. 19–66). Cambridge, MA:
Cambridge University Press.
Bright, P., Buckman, J., Fradera, A., Yoshimasu, H., Colchester, A. C., & Kopelman, M.
D. (2006). Retrograde amnesia in patients with hippocampal, medial temporal,
temporal lobe, or frontal pathology. Learning & Memory, 13(5), 545–557.
Cabeza, R., & Nyberg, L. (2000). Imaging cognition II: An empirical review of 275 PET
and fMRI studies. Journal of Cognitive Neuroscience, 12, 1–47.
Campodonico, J. R., & Rediess, S. (1996). Dissociation of implicit and explicit knowl-
edge in a case of psychogenic retrograde amnesia. Journal of the International
Neuropsychological Society: JINS, 2(2), 146–158.
Cloninger, C. R., Svrakic, D. M., & Przybeck, T. R. (1993). A psychobiological model of
temperament and character. Archives of General Psychiatry, 50, 975–990.
Conway, M. A., & Pleydell-Pearce, C. W. (2000). The construction of autobiographical
memories in the self-memory system. Psychological Review, 107(2), 261–288.
Craig, A. D. (2002). How do you feel? Interoception: The sense of the physiological
condition of the body. Nature Reviews Neuroscience, 3(8), 655–666.
Craig, A. D. (2004). Human feelings: Why are some more aware than others? Trends
in Cognitive Sciences, 8(6), 239–241.
Damasio, A. (1989). Time-locked multiregional retroactivation: A systems-level pro-
posal for the neural substrates of recall and recognition. Cognition, 33, 25–62.
Daselaar, S. M., Rice, H. J., Greenberg, D. L., LaBar, K. S., & Rubin, D. C. (2008). The spa-
tiotemporal dynamics of autobiographical memory: Neural correlates of recall,
emotional intensity and reliving. Cerebral Cortex, 18, 217–229.
De Renzi, E., & Lucchelli, F. (1993). Dense retrograde amnesia, intact learning capabil-
ity and abnormal forgetting rate: A consolidation deficit? Cortex, 29(3), 449–466.
Dolcos, F., LaBar, K. S., & Cabeza, R. (2004). Interaction between the amygdala and
the medial temporal lobe memory system predicts better memory for emotional
events. Neuron, 42, 855–863.
Dorahy, M. J. (2006). The dissociative processing style: A cognitive organization acti-
vated by perceived or actual threat in clinical dissociators. Journal of Trauma
Dissociation, 7(4), 29–53.
Erdelyi, M. H. (2006). The unified theory of repression. Behavioral and Brain Sciences,
29, 499–551.
Fast, K., & Engel, R. R. (2007). Halstead Category Test—Deutsche Version (HCT-D). Göt-
tingen: Hogrefe.
Fast, K., Fujiwara, E., & Markowitsch, H.-J. (2007). Famous Faces Test (FFT). Göttingen:
Hogrefe.
Fast, K., Fujiwara, E., Schröder, J., & Markowitsch, H.-J. (2007). Erweitertes Autobi-
ographisches Gedächtnisinterview (E-AGI). Frankfurt: Harcourt.
Freyberger, H., Spitzer, C., & Stieglitz, R. (1998). Fragebogen zu dissoziativen Symp-
tomen FDS (Aufl. 1). Bern: Hans Huber.
Gardini, S., De Beni, R., Cornoldi, C., Bromiley, A., & Venneri, A. (2005). Different neu-
ronal pathways support the generation of general and specific mental images.
Neuroimage, 27(3), 544–552.
Gardini, S., Cornoldi, C., De Beni, R., & Venneri, A. (2006). Left mediotemporal
structures mediate the retrieval of episodic autobiographical mental images.
Neuroimage, 30(2), 645–655.
Gilboa, A., Winocur, G., Grady, C. L., Hevenor, S. J., & Moscovitch, M. (2004). Remem-
bering our past: Functional neuroanatomy of recollection of recent and very
remote personal events. Cerebral Cortex, 14, 1214–1225.
Glisky, E. L., Ryan, L., Reminger, S., & Hardt, O. (2004). A case of psychogenic fugue:
I understand, aber ich verstehe nichts. Neuropsychologia, 42, 1132–1147.
Goebel, R. (2006). Brain Voyager QX (version 2.2) (Computer software and manual).
The Netherlands: Maastricht Brain Innovation B.V.
Greenberg, D. L., Eacott, M. J., Brechin, D., & Rubin, D. C. (2005). Visual mem-
ory loss and autobiographical amnesia: A case study. Neuropsychologia, 43(10),
1493–1502.
Greenberg, D. L., & Rubin, D. C. (2003). The neuropsychology of autobiographical
memory. Cortex, 39(4–5), 687–728.
Guralnik, O., Schmeidler, J., & Simeon, D. (2000). Feeling unreal: Cognitive processes
in depersonalization. American Journal of Psychiatry, 157(1), 103–109.
Gusnard, D. A., Akbudak, E., Shulman, G. L., & Raichle, M. E. (2001). Medial prefrontal
cortex and self-referential mental activity: Relation to a default mode of brain
function. Proc Natl Acad Sci USA, 98(7), 4259–4264.
Härting, C., Markowitsch, H.-J., Neufeld, H., Calabrese, P., Deisinger, K., & Kessler, J.
(2000). Wechsler Gedächtnis Test—Revidierte Fassung (WMS-R). Bern: Huber.
Intons-Peterson, M., & McDaniel, M. (1991). Symmetries and asymmetries between
imagery and perception. In C. Cornoldi & M. A. McDaniel (Eds.), Imagery and
Cognition (pp. 47–76). New York: Springer.
Johnson, M. K., Raye, C. L., Mitchell, K. J., Touryan, S. R., Greene, E. J., & Nolen-
Hoeksema, S. (2006). Dissociating medial frontal and posterior cingulate activity
during self-reflection. Social Cognitive and Affective Neuroscience, 1(1), 56–64.
Kapur, S., Scholey, K., Moore, E., Barker, S., Brice, J., & Thompson, S. (1996). Long-term
retention-deficits in two cases of disproportionate retrograde amnesia. Journal
of Cognitive Neuroscience, 8, 416–434.
Kessler, J., Schaaf, A., & Mielke, R. (1993). Fragmentierter Bildertest (FBT). Göttingen:
Hogrefe.
Konishi, S., Wheeler, M. E., Donaldson, D. I., & Buckner, R. L. (2000). Neural correlates
of episodic retrieval success. Neuroimage, 12, 276–286.
 K. Hennig-Fast et al. / Neuropsychologia 46 (2008) 2993–3005
Kopelman, M. D. (2000a). Focal retrograde amnesia and the attribution of causal-
ity: An exceptionally critical review. Cognitive Neuropsychology, 17, 585–
621.
Kopelman, M. D. (2000b). Fear can interrupt the continuum of memory. Journal of
Neurology, Neurosurgery, and Psychiatry, 69(4), 431–432.
Kopelman, M., Wilson, B., & Baddeley, A. (1990). The autobiographical Memory Inter-
view. Bury St. Edmunds: Thames Valley Test Company.
Kopelman, M. D., Christensen, H., Puffett, A., & Stanhope, N. (1994). The great escape:
A neuropsychological study of psychogenic amnesia. Neuropsychologia, 32(6),
675–691.
Kosslyn, S. M., Ganis, G., & Thompson, W. L. (2001). Neural foundations of imagery.
Nature Review: Neuroscience, 2, 635–642.
Kritchevsky, M., Chang, J., & Squire, L. R. (2004). Functional amnesia: Clinical descrip-
tion and neuropsychological profile of 10 cases. Learning & Memory, 11(2),
213–226.
Levine, B., Black, S. E., Cabeza, R., Sinden, M., Mcintosh, A. R., Toth, J. P., Tulving, E., &
Stuss, D. T. (1998). Episodic memory and the self in a case of isolated retrograde
amnesia. Brain, 121, 1951–1973.
Levine, B., Turner, G. R., Tisserand, D., Hevenor, S. J., Graham, S. J., & McIntosh,
A. R. (2004). The functional neuroanatomy of episodic and semantic autobio-
graphical remembering: A prospective functional MRI study. Journal of Cognitive
Neuroscience, 16, 1633–1646.
MacLeod, M. D., & Macrae, C. N. (2001). Gone but not forgotten: The transient nature
of retrieval-induced forgetting. Psychological Science, 12, 148–152.
Markowitsch, H. J., Calabrese, P., Fink, G. R., Durwen, H. F., Kessler, J., Härting, C.,
König, M., Mirzaian, E. B., Heiss, W.-D., Heuser, L., & Gehlen, W. (1997). Impaired
episodic memory retrieval in a case of probable psychogenic amnesia. Psychiatry
Research: Neuroimaging Section, 74, 119–126.
Markowitsch, H. J., Fink, G. R., Thöne, A. I. M., Kessler, J., & Heiss, W.-D. (1997).
Persistent psychogenic amnesia with a PET-proven organic basis. Cognitive Neu-
ropsychiatry, 2, 135–158.
Markowitsch, H. J., Vandekerckhove, M. M., Lanfermann, H., & Russ, M. O. (2003).
Engagement of lateral and medial prefrontal areas in the ecphory of sad and
happy autobiographical memories. Cortex, 39(4–5), 643–665.
Martin, A. (2001). Functional neuroimaging of semantic memory. In R. Cabeza & A.
Kingstone (Eds.), Handbook of functional neuroimaging of cognition (pp. 153–186).
London, England: The MIT Press.
Moscovitch, M., Rosenbaum, R. S., Gilboa, A., Addis, D. R., Westmacott, R., Grady, C.,
McAndrews, M. P., Levine, B., Black, S., & Winocur, G. (2005). Functional neu-
roanatomy of remote episodic, semantic and spatial memory: A unified account
based on multiple trace theory. Journal of Anatomy, 207, 35–66.
Moscovitch, M., & Melo, B. (1997). Strategic retrieval and the frontal lobes: Evidence
from confabulation and amnesia. Neuropsychologia, 35, 1017–1034.
Nakamura, H., Kunori, Y., Mori, K., Nakaaki, S., Yoshida, S., & Hamanaka, T. (2002).
Two cases of functional focal retrograde amnesia with impairment of object use.
Cortex, 38, 613–622.
Papagno, C. (1998). Transient retrograde amnesia associated with impaired naming
of living categories. Cortex, 34(1), 111–121.
Paulus, M. P., Rogalsky, C., Simmons, A., Feinstein, J. S., & Stein, M. B. (2003). Increased
activation in the right insula during risk taking decision making is related to
harm avoidance and neuroticism. NeuroImage, 19, 1439–1448.
Piefke, M., Weiss, P. H., Zilles, K., Markowitsch, H. J., & Fink, G. R. (2003). Differential
remoteness and emotional tone modulate the neural correlates of autobiograph-
ical memory. Brain, 126, 650–668.
Radley, J. J., Arias, C. M., & Sawchenko, P. E. (2006). Regional differentiation of the
medial prefrontal cortex in regulating adaptive responses to acute emotional
stress. Journal of Neuroscience, 26(50), 12967–12976.
Reitan, R. M. (1986). Trail-making test manual for administration and scoring. Tucson,
AZ: Reitan Neuropsychology Laboratory.
3005
Repetto, C., Manenti, R., Sansone, V., Cotelli, M., Perani, D., Garibotto, V., Zanetti, O.,
Meola, G., & Miniussi, C. (2007). Persistent autobiographical amnesia: A case
report. Behavioural Neurology, 18(1), 13–17.
Rubin, D. C. (2005). A basic-systems approach to autobiographical memory. Current
Directions in Psychological Science, 14, 79–83.
Rubin, D. C. (2006). The basic-systems model of episodic memory. Perspectives on
Psychological Science, 1, 277–311.
Rubin, D. C., & Greenberg, D. L. (1998). Visual memory-deficit amnesia: A distinct
amnesic presentation and etiology. Proc Natl Acad Sci USA, 95(9), 5413–5416.
Rubin, D. C., Schrauf, R. W., & Greenberg, D. L. (2003). Belief and recollection of
autobiographical memories. Memory & Cognition, 31(6), 887–901.
Sakai, K., & Miyashita, Y. (1994). Neuronal tuning to learned complex forms in vision.
Neuroreport, 5(7), 829–832.
Schacter, D. L., Wang, P. L., Tulving, E., & Freedman, M. (1982). Functional retrograde
amnesia: A quantitative case study. Neuropsychologia, 20(5), 523–532.
Sellal, F., Manning, L., Seegmuller, C., Scheiber, C., & Schoenfelder, F. (2002). Pure
retrograde amnesia following a mild head trauma: A neuropsychological and
metabolic study. Cortex, 38(4), 499–509.
Spreen, O., & Strauss, E. (1998). A Compendium of neuropsychological tests: Adminis-
tration, norms, and commentary (2nd ed.). NY: Oxford University Press.
Starkstein, S. E., Sabe, L., & Dorego, M. F. (1997). Severe retrograde amnesia after a
mild closed head injury. Neurocase, 3, 105–109.
Stein, M. B., Simmons, A. N., Feinstein, J. S., & Paulus, M. P. (2007). Increased amyg-
dala and insula activation during emotion processing in anxiety-prone subjects.
American Journal of Psychiatry, 164(2), 318–327.
Stracciari, A., Ghidoni, E., Guarino, M., Poletti, M., & Pazzaglia, P. (1994). Post-
traumatic retrograde amnesia with selective impairment of autobiographic
memory. Cortex, 30, 459–468.
Svoboda, E., McKinnon, M. C., & Levine, B. (2006). The functional neuroanatomy
of autobiographical memory: A meta-analysis. Neuropsychologia, 44(12),
2189–2208.
Talairach, J., & Tournoux, P. (1988). Co-planar stereotaxic atlas of the human brain.
New York: Thieme Medical.
Talarico, J. M., LaBar, K. S., & Rubin, D. C. (2004). Emotional intensity predics autobi-
ographical memory experience. Memory & Cognition, 32, 1118–1132.
Teng, E., & Squire, L. R. (1999). Memory for places learned long ago is intact after
hippocampal damage. Nature, 400(6745), 675–677.
Tewes, U. (1991). Hamburg-Wechsler-Intelligenztest für Erwachsene Revision.
Bern/Stuttgart/Toronto: Verlag Hans Huber.
Tombaugh, T. N., Rees, L., & McIntyre, N. (1996). Normative data for the Trail Making
Test. Personal communication. In O. Spreen & E. Strauss (Eds.), A Compendium of
Neuropsychological Tests. Oxford, N.Y.: Oxford University Press, p. 540.
Tulving, E. (1983). Elements of episodic memory. Oxford: Clarendon Press.
Tulving, E. (1989). Remembering and knowing the past. American Scientist, 77,
361–367.
Tulving, E. (2002). Episodic memory: From mind to brain. Annual Review of Psychol-
ogy, 53, 1–25.
Wheeler, M. E., & Buckner, R. L. (2004). Functional anatomic correlates of remem-
bering and knowing. Neuroimage, 21, 1249–1337.
Wittchen, H.-U., Wunderlich, U., Gruschwitz, S., & Zaudig, M. (1996). Strukturiertes
Klinisches Interview für DSM-IV (SKID). Göttingen: Beltz-Test.
World Health Organisation. (1992). The ICD-10 classification of mental and behavioural
disorders, clinical descritions and diagnostic guidelines. Genève: World Health
Organization.
Yeudall, L. T., Reddon, J. R., Gill, D. M., & Stefanyk, W. O. (1987). Normative data for
the Halstead-Reitan neuropsychiological tests stratified by age and sex. Journal
of Clinical Psychology, 43, 346–367.
Zimmermann, P., & Fimm, B. (1993). Testbatterie zur Aufmerksamkeitsprüfung (TAP).
München: Psytest.